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From the Editor |
The Woeful Neglect Of Health Care Workforce Issues
More than two decades ago the report of the Graduate Medical Education National Advisory Committee (GMENAC) represented both the high-water mark for the science of physician workforce projection and the onset of a reaction against workforce planning of any sort. The GMENAC report of 1981 suggested that the nation had produced too many physicians. That conclusion, coupled with the pro-market, anti-planning mentality of the incoming Reagan administration, led to a long lapse of governmental and academic attention to physician workforce policy issues. Now, the subject of the health care workforce is making its way back on the public policy agenda, fueled mostly by serious concern over a shortage of nurses. But not too far behind is a growing uncertainty over whether GMENAC’s planners were right when they projected a surfeit of physicians by the year 2000.
Given the intense interest in the nursing shortage, uncertainties over whether the supply of physicians is adequate, and countless other issues involving dentists, pharmacists, and other health professionals; cross-professions concerns about insufficient diversity; the impact of informatics; and the adequacy of providers trained to care for the growing elderly population, we are largely devoting this volume to the health care workforce. Health Affairs contributing editor Fitzhugh Mullan, formerly director of the federal Bureau of Health Professions, has served skillfully as the lead editor for this thematic issue. Critical to the production of the issue (and the maintenance of our annual subscription price at an affordable level) was the support we derived from four foundations, all of which have invested resources in examining the adequacy of the health care workforce and ways it could better serve the public. We gratefully acknowledge support from the California HealthCare Foundation, the John A. Hartford Foundation, the W.K. Kellogg Foundation, and the Josiah Macy Jr. Foundation.
While the GMENAC report may have missed the mark, there is certainly no unanimity in answer to the question, Does the United States face a shortage or a surplus of physicians? One thing is certain: Health Affairs will continue to focus attention on this and related workforce issues because they have for too long been neglected. In our January/February 2002 issue we published an essay by Richard Cooper and colleagues (p. 140) that asserted that a physician shortage loomed, particularly of medical specialists. Seven respondents to the paper largely disagreed with this assessment. But Cooper’s paper was the major influence in convincing the Association of American Medical Colleges (AAMC) that it should (1) adopt a more neutral stance on the question of physician supply and (2) call for an in-depth analysis of the trends affecting the aggregate supply of future doctors. Before this policy change, adopted 20 June 2002 by its Executive Council, the AAMC had recommended steps to reduce physician supply to obviate the surplus predicted by GMENAC and some academics.
In this issue Kevin Grumbach leads off with a strong plea that given the renewed debate around the adequacy of the nation’s physician supply, Congress should create "a more rational and accountable system of federal physician workforce regulation and funding." Uwe Reinhardt follows with a dissenting view, calling instead for the creation of a program through which new physicians would repay the generous public subsidies they receive during their training years by providing medical care to underserved or uninsured individuals for a specified period. These papers are followed by a wealth of new information on workforce-related subjects, particularly those having to do with nursing. While President Bush signed into law August 1 (2002) legislation that will establish scholarships and create other programs to address the nation’s nursing shortage, the papers here underscore the depth of the nursing dilemma. One paper (by Julie Sochalski) points out that to retain or attract back nurses, hospitals and other facilities must offer enhanced career ladders, better wages, flexible hours, and a more satisfying workplace. Other papers address the gap between nursing schools and hospitals, the implications of minimum nurse-to-patient ratios in acute care hospitals, and the role of nurse practitioners. Another paper (by Christine Kovner and colleagues) discusses the dearth of available professionals to care for the growing population of older Americans.
Finally, to encourage greater dialogue in real time between authors and readers, we have begun accepting Letters to the Editor on our Web site, www.healthaffairs.org. With infinite space available and our penchant stronger than ever for provoking more discussions among academe, government, and the private sector, we hope that all of our readers will consider this invitation to engage the continuing health policy debates either on the Web or within the journal.
Founding Editor
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